| NPI | 1518521012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC011533) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: GA APC--6464) |
| Enumeration Date | 2019-04-30 |
| Last Update Date | 2021-03-23 |