| NPI | 1942661848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: GA 620) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: GA 1839) |
| Enumeration Date | 2016-03-19 |
| Last Update Date | 2016-03-19 |