| NPI | 1487762191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: VA 0701001985) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: VA 0717000333) |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2023-11-07 |