| NPI | 1851289656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: GA MFT002053) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: GA MFT002053) |
| Enumeration Date | 2025-06-27 |
| Last Update Date | 2025-06-27 |