| NPI | 1942304308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: VA 0717-000004) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: VA 0701001162) |
| Enumeration Date | 2006-09-07 |
| Last Update Date | 2011-10-04 |