| NPI | 1750528949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: VA 0717000512) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: DC 1295) |
| Enumeration Date | 2009-01-10 |
| Last Update Date | 2012-06-19 |