| NPI | 1619153046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701002547) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VA 0718000068) |
| 106H00000X Marriage & Family Therapist (Licence: VA 0717000421) | |
| Enumeration Date | 2008-01-16 |
| Last Update Date | 2018-07-31 |