| NPI | 1700959095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701002183) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2013-09-06 |