| NPI | 1851375836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VA 0701001496) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: VA 0717000603) |
| Enumeration Date | 2005-12-02 |
| Last Update Date | 2008-10-02 |