| NPI | 1154460855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: GA LPC003047) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: GA 3045) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2017-10-12 |