| NPI | 1558516336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA 000887) |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral (Licence: no license provided) |
| 106H00000X Marriage & Family Therapist (Licence: GA 000500) | |
| Enumeration Date | 2008-11-20 |
| Last Update Date | 2008-11-20 |