| NPI | 1730609843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: GA MFT001668) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: GA LPC011271) |
| 106H00000X Marriage & Family Therapist (Licence: GA AMT000381) | |
| Enumeration Date | 2017-06-21 |
| Last Update Date | 2020-05-20 |