| NPI | 1144654328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC009044) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: GA APC003956) |
| Enumeration Date | 2013-08-24 |
| Last Update Date | 2020-08-26 |