| NPI | 1346548450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC002968) |
| Additional Taxonomies | 101YS0200X Counselor, School (Licence: GA 219809) |
| Enumeration Date | 2011-03-14 |
| Last Update Date | 2011-03-14 |