| NPI | 1730322611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: VA 0717001246) |
| Additional Taxonomies | 102L00000X Psychoanalyst (Licence: VA 0717001246) |
| 101Y00000X Counselor (Licence: VA 0717001246) | |
| 101YM0800X Counselor, Mental Health (Licence: VA 0717001246) | |
| 101YP1600X Counselor, Pastoral (Licence: VA 0717001246) | |
| Enumeration Date | 2009-04-08 |
| Last Update Date | 2012-08-09 |