| NPI | 1740360320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: VA 0717000430) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VA 0701001343) |
| 101YM0800X Counselor, Mental Health (Licence: NC 2693) | |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2025-09-11 |