| NPI | 1437689122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: GA MFT001759) |
| Additional Taxonomies | 171W00000X Contractor |
| Enumeration Date | 2017-06-14 |
| Last Update Date | 2023-02-21 |