| NPI | 1821237728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: VA 0717000898) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VA 0701001531) |
| Enumeration Date | 2009-02-17 |
| Last Update Date | 2015-10-06 |