| NPI | 1972591972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: VA 0717000178) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VA 0718000044) |
| 101YM0800X Counselor, Mental Health (Licence: VA 0701000627) | |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2019-08-06 |