| NPI | 1326582990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: GA LPC011588) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NY 010427) |
| Enumeration Date | 2016-12-15 |
| Last Update Date | 2026-04-09 |