| NPI | 1780675785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: GA 000290) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: GA 000279) |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2007-07-08 |