| NPI | 1346679925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: GA LPC010127) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 006574) |
| Enumeration Date | 2013-11-05 |
| Last Update Date | 2022-12-12 |