| NPI | 1255107173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: GA LPC015776) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: GA AMFT000740) |
| Enumeration Date | 2023-12-01 |
| Last Update Date | 2025-05-14 |