| NPI | 1093986002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: VA 0701003612) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: VA 0717001075) |
| Enumeration Date | 2008-03-18 |
| Last Update Date | 2008-03-18 |