| NPI | 1114643400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC015244) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AL LPC04633) |
| Enumeration Date | 2022-10-18 |
| Last Update Date | 2025-11-13 |