| NPI | 1295187581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: GA CSW000901) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: GA MFT 000497) |
| Enumeration Date | 2016-07-11 |
| Last Update Date | 2016-07-11 |