| NPI | 1275829426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC007270) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH23962) |
| Enumeration Date | 2011-06-27 |
| Last Update Date | 2024-08-14 |