| NPI | 1992888697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VA 0701003224) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: VA 0717001028) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2007-07-09 |