| NPI | 1770709040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: GA 1545) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: GA 1545) |
| 101YP2500X Counselor Professional (Licence: GA 1545) | |
| 106H00000X Marriage & Family Therapist (Licence: GA 1545) | |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2008-06-26 |