| NPI | 1588066518 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC006267) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2014-09-22 |
| Last Update Date | 2023-05-23 |