| NPI | 1790871366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: VA 0717000256) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH7594) |
| 101YP2500X Counselor, Professional (Licence: VA 0701000125) | |
| 103TC0700X Psychologist, Clinical (Licence: VA 0810001832) | |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2025-09-11 |