| NPI | 1487742615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VA lpc 0701002320) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: VA lmft 0717000267) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2007-07-08 |