| NPI | 1740321629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 701002939) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: VA 701002939) |
| 106H00000X Marriage & Family Therapist (Licence: VA 701002939) | |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2007-07-08 |