| NPI | 1386933786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: VA 0701001862) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: VA 0717000148) |
| Enumeration Date | 2011-04-06 |
| Last Update Date | 2011-04-06 |