| NPI | 1285606004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: VA 0717001062) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VA 0701003504) |
| Enumeration Date | 2006-02-06 |
| Last Update Date | 2013-04-29 |