| NPI | 1437134871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC001176) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: GA MFT000464) |
| Enumeration Date | 2005-12-08 |
| Last Update Date | 2025-09-11 |