| NPI | 1154472470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: GA CSW001054) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: GA MFT000260) |
| Enumeration Date | 2007-01-15 |
| Last Update Date | 2007-07-08 |