| NPI | 1265972129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC009224) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: GA LPC009224) |
| 101YM0800X Counselor, Mental Health (Licence: GA LPC009224) | |
| Enumeration Date | 2017-02-27 |
| Last Update Date | 2023-12-01 |