| NPI | 1164821799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA APC008142) |
| Additional Taxonomies | 222Q00000X Developmental Therapist |
| Enumeration Date | 2014-08-20 |
| Last Update Date | 2022-03-01 |