| NPI | 1619103140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: VA 0701001747) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: VA 0717000693) |
| Enumeration Date | 2009-06-10 |
| Last Update Date | 2009-06-10 |