| NPI | 1871635417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: GA 1204) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: GA 1204) |
| 106H00000X Marriage & Family Therapist (Licence: GA 567) | |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2024-04-18 |