| NPI | 1841330867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA 004943) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: GA 001026) |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2015-04-01 |