| NPI | 1295203610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC012255) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AL LPC03905) |
| Enumeration Date | 2018-11-02 |
| Last Update Date | 2024-11-07 |