NPI | 1679801781 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701001696) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: VA 0717000532) |
Enumeration Date | 2009-12-01 |
Last Update Date | 2009-12-01 |