| NPI | 1427532761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC011779) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: GA APC005861) |
| Enumeration Date | 2018-09-22 |
| Last Update Date | 2023-02-13 |