| NPI | 1851696116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: VA 0717000474) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VA 0701001637) |
| Enumeration Date | 2011-01-18 |
| Last Update Date | 2011-01-18 |