| NPI | 1275501256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: VA 0717000031) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VA 0701001766) |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2015-01-12 |