| NPI | 1366444572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC003018) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VA 0701013259) |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2024-02-16 |