| NPI | 1528539715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: VA 071701510) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: VA 0717001510) |
| Enumeration Date | 2018-12-16 |
| Last Update Date | 2018-12-16 |