| NPI | 1417140666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: GA MFT001129) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: GA LPC006033) |
| Enumeration Date | 2007-08-21 |
| Last Update Date | 2016-06-27 |