| NPI | 1366724734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: GA MFT001190) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: GA LPC006828) |
| Enumeration Date | 2011-09-12 |
| Last Update Date | 2012-07-29 |