| NPI | 1336116375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: GA PSY001400) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: GA PSY001400) |
| 106H00000X Marriage & Family Therapist (Licence: GA PSY001400) | |
| 101YP1600X Counselor, Pastoral (Licence: GA PSY001400) | |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2011-08-17 |