| NPI | 1538499595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904002459) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: VA 0717000284) |
| Enumeration Date | 2010-01-13 |
| Last Update Date | 2016-09-05 |