| NPI | 1417004565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701002217) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: VA 49857) |
| 106H00000X Marriage & Family Therapist (Licence: VA 0717000260) | |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2012-09-28 |