| NPI | 1316965122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: VA 0701002658) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: VA 0717000656) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2007-07-08 |