| NPI | 1255504015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC002826) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: GA LPC002826) |
| Enumeration Date | 2008-04-11 |
| Last Update Date | 2018-06-16 |