| NPI | 1134257728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC005339) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2023-12-20 |