| NPI | 1134368020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: GA LPC005725) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: GA APC001412) |
| Enumeration Date | 2009-02-17 |
| Last Update Date | 2014-04-02 |