| NPI | 1598715997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: GA MFT000410) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: GA LPC000831) |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2019-06-14 |