| NPI | 1104568732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: GA LPC011535) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: GA LPC011535) |
| Enumeration Date | 2022-04-13 |
| Last Update Date | 2022-04-13 |