| NPI | 1568695021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: GA LPC005656) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AL 2786) |
| Enumeration Date | 2009-09-01 |
| Last Update Date | 2020-10-12 |