| NPI | 1316370547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251S00000X (Licence: GA LPC007339) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: GA LPC007339) |
| Enumeration Date | 2013-08-12 |
| Last Update Date | 2017-10-26 |