| NPI | 1407964067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC003989) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC 10112) |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2013-10-01 |