| NPI | 1053808246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC006389) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: FL SS1866) |
| Enumeration Date | 2018-04-13 |
| Last Update Date | 2024-05-30 |