| NPI | 1194885764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: VA LPC0701001916) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: VA LMFT0717000683) |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2007-07-08 |