NPI | 1982712071 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor Professional (Licence: VA 1887) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: VA 0717000162) |
Enumeration Date | 2006-08-28 |
Last Update Date | 2025-06-20 |