NPI | 1245470129 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA 333) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: GA 331) |
Enumeration Date | 2009-03-04 |
Last Update Date | 2009-03-04 |