| NPI | 1609048933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC000103) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: GA CSW002833) |
| 106H00000X Marriage & Family Therapist (Licence: GA MFT000167) | |
| Enumeration Date | 2008-03-27 |
| Last Update Date | 2008-06-27 |