| NPI | 1427197011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701000143) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: NE 336) |
| 106H00000X Marriage & Family Therapist (Licence: VA 0717000875) | |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2007-07-08 |