| NPI | 1245601863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701006350) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VA 0710103043) |
| 106H00000X Marriage & Family Therapist (Licence: VA 0717001413) | |
| Enumeration Date | 2015-10-08 |
| Last Update Date | 2016-11-22 |