| NPI | 1679626212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA 1470) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: GA 717) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2007-07-08 |