| NPI | 1750840765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: GA MFT001690) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: GA LPC012899) |
| 106H00000X Marriage & Family Therapist (Licence: LA 1315) | |
| Enumeration Date | 2019-03-19 |
| Last Update Date | 2022-09-15 |