| NPI | 1992824932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: GA 001169) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 106H00000X Marriage & Family Therapist (Licence: CT 003450) | |
| 101YP2500X Counselor Professional | |
| 101YS0200X Counselor School | |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2024-09-26 |