| NPI | 1730622812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MO 2015004635) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MO 2015002796) |
| 101YP2500X Counselor, Professional (Licence: VA 0701005546) | |
| 106H00000X Marriage & Family Therapist (Licence: VA 0717001326) | |
| Enumeration Date | 2016-11-22 |
| Last Update Date | 2016-11-22 |