| NPI | 1306046933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC011164) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: SC 8164) |
| Enumeration Date | 2007-07-22 |
| Last Update Date | 2026-01-08 |