| NPI | 1306125380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: GA MFT1238) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: GA AMFT000208) |
| Enumeration Date | 2011-08-09 |
| Last Update Date | 2014-05-14 |