| NPI | 1134585631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC009564) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: GA 003891) |
| Enumeration Date | 2016-01-13 |
| Last Update Date | 2017-05-09 |