| NPI | 1316199136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NM 0113221) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VA 0701002099) |
| 106H00000X Marriage & Family Therapist (Licence: NM 0113371) | |
| 106H00000X Marriage & Family Therapist (Licence: VA 0717000008) | |
| Enumeration Date | 2008-10-13 |
| Last Update Date | 2018-08-02 |