| NPI | 1275848053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: VA 0701000807) |
| Additional Taxonomies | 103TS0200X Psychologist School (Licence: VA PENDING RENEWAL) |
| Enumeration Date | 2010-08-17 |
| Last Update Date | 2010-08-17 |