| NPI | 1235402926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC006777) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AL 3002) |
| 101YP2500X Counselor, Professional (Licence: AL 3002) | |
| Enumeration Date | 2012-02-11 |
| Last Update Date | 2026-01-12 |