| NPI | 1316300270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC007921) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH14179) |
| Enumeration Date | 2016-03-29 |
| Last Update Date | 2022-06-01 |