| NPI | 1487709481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: GA LPC005075) |
| Additional Taxonomies | 101YP1600X Counselor Pastoral |
| 106H00000X Marriage & Family Therapist (Licence: GA MFT001232) | |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2012-07-10 |