| NPI | 1528201282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: GA LMFT 829) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: GA LPC 1620) |
| Enumeration Date | 2009-04-10 |
| Last Update Date | 2012-12-10 |