| NPI | 1700283215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: GA MFT001315) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: GA LPC007424) |
| Enumeration Date | 2014-11-26 |
| Last Update Date | 2021-08-13 |