| NPI | 1255463840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810002770) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VA 0701002542) |
| 106H00000X Marriage & Family Therapist (Licence: VA 0717000627) | |
| Enumeration Date | 2007-03-10 |
| Last Update Date | 2022-02-08 |