| NPI | 1154618643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA 101YP2500X- LPC00610) |
| Additional Taxonomies | 101YS0200X Counselor, School (Licence: GA 101YS0200X- 723411) |
| Enumeration Date | 2011-07-05 |
| Last Update Date | 2011-07-05 |