| NPI | 1245472596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: GA mft001160) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: GA LPC005474) |
| Enumeration Date | 2009-04-01 |
| Last Update Date | 2012-07-15 |