| NPI | 1396963252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401018346) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: GA LPC001422) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2020-11-05 |