| NPI | 1295274025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: GA LPC008851) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: GA MFT001469) |
| Enumeration Date | 2017-02-13 |
| Last Update Date | 2017-02-13 |