| NPI | 1942316971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: GA PSY001889) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: GA LPC001940) |
| 106H00000X Marriage & Family Therapist (Licence: GA MFT000810) | |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2010-08-11 |