| NPI | 1467683482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0717000077) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VA 0718000207) |
| 106H00000X Marriage & Family Therapist (Licence: VA 0717000077) | |
| Enumeration Date | 2009-08-07 |
| Last Update Date | 2017-02-09 |