| NPI | 1346987773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC015358) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC 22247) |
| 101YP2500X Counselor, Professional (Licence: SC 11121) | |
| Enumeration Date | 2022-05-17 |
| Last Update Date | 2025-12-03 |