| NPI | 1164108601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC010578) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 82135) |
| Enumeration Date | 2023-06-27 |
| Last Update Date | 2024-12-26 |