| NPI | 1316276645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: GA LPC004761) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: GA 004761) |
| Enumeration Date | 2009-12-16 |
| Last Update Date | 2024-07-17 |