| NPI | 1740285691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701001119) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: VA 0717000732) |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2007-07-09 |