| NPI | 1073759130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC008803) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: AR A0808055) |
| Enumeration Date | 2008-12-19 |
| Last Update Date | 2021-01-20 |