| NPI | 1134534068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC010027) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: GA APC004405) |
| Enumeration Date | 2014-06-30 |
| Last Update Date | 2022-05-11 |