| NPI | 1518246289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701002027) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: VA 0717000167) |
| Enumeration Date | 2011-08-11 |
| Last Update Date | 2020-05-08 |