| NPI | 1285606566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: VA 0717001186) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VA 0701003702) |
| 101YM0800X Counselor, Mental Health (Licence: SC 3786) | |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2009-05-23 |