| NPI | 1619052412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 2037) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: GA 3110) |
| 106H00000X Marriage & Family Therapist (Licence: NC 538) | |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2007-07-08 |