| NPI | 1245460849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC002833) |
| Additional Taxonomies | 101YS0200X Counselor, School (Licence: GA 634508) |
| Enumeration Date | 2009-07-17 |
| Last Update Date | 2009-07-21 |