| NPI | 1811057722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: VA LPC0701001782) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: VA LMFT07170000740) |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2007-07-08 |