| NPI | 1407061153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: GA MFT 877) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: FL MH 0879) |
| 106H00000X Marriage & Family Therapist (Licence: FL MT 1041) | |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2007-07-11 |