| NPI | 1285984641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AL 3077) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: GA LPC006956) |
| 106H00000X Marriage & Family Therapist (Licence: AL 380) | |
| 106H00000X Marriage & Family Therapist (Licence: GA MFT001269) | |
| Enumeration Date | 2012-09-13 |
| Last Update Date | 2019-09-10 |