| NPI | 1023477569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC010189) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VA 0701006471) |
| Enumeration Date | 2016-02-11 |
| Last Update Date | 2019-01-02 |