| NPI | 1982746467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC180) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AL LPC488) |
| 106H00000X Marriage & Family Therapist (Licence: GA MFT349) | |
| 106H00000X Marriage & Family Therapist (Licence: AL MFT111) | |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2007-07-08 |