| NPI | 1629487111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: VA 0717000869) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: VA 0701001741) |
| Enumeration Date | 2014-08-08 |
| Last Update Date | 2022-09-02 |