| NPI | 1528134913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: VA 0701002560) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: VA 0717000519) |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2007-07-08 |