| NPI | 1366462970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: VA 0717000355) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VA 0718000106) |
| 101YM0800X Counselor, Mental Health (Licence: VA 0701002601) | |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2019-03-27 |