| NPI | 1336350164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: VA 30187) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VA 0701001918) |
| 101YP2500X Counselor, Professional (Licence: AZ LC 2332) | |
| 106H00000X Marriage & Family Therapist (Licence: VA 0717000697) | |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2007-07-08 |