| NPI | 1649651597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: VA 0717001569) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: VT 100.0114640) |
| 106H00000X Marriage & Family Therapist (Licence: NH 183) | |
| Enumeration Date | 2015-06-16 |
| Last Update Date | 2024-08-01 |