| NPI | 1235240805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: VA 0717000089) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: VA 0701002039) |
| 106H00000X Marriage & Family Therapist (Licence: TX 3476) | |
| 106H00000X Marriage & Family Therapist (Licence: NC 521) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2019-12-17 |