| NPI | 1598633901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: GA MFT002226) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: GA LPC015974) |
| Enumeration Date | 2025-10-27 |
| Last Update Date | 2025-10-27 |