| NPI | 1578137345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC007531) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MO 201103628) |
| Enumeration Date | 2021-05-17 |
| Last Update Date | 2023-10-17 |