| NPI | 1932284767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: VA 0701000668) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: VA 0717000695) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2007-07-08 |