| NPI | 1548513807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: VA 0717002157) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YP1600X Counselor, Pastoral | |
| Enumeration Date | 2012-10-23 |
| Last Update Date | 2026-01-14 |