| NPI | 1275783664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: GA LPC007843) |
| 101YS0200X Counselor, School (Licence: GA 909669) | |
| Enumeration Date | 2008-09-23 |
| Last Update Date | 2024-03-08 |