| NPI | 1255107173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: GA AMFT000740) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: GA APC008356) |
| Enumeration Date | 2023-12-01 |
| Last Update Date | 2023-12-01 |