| NPI | 1205266103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810005276) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VA 070100 6143) |
| 106H00000X Marriage & Family Therapist (Licence: VA 071700 1344) | |
| Enumeration Date | 2013-11-14 |
| Last Update Date | 2024-08-14 |