| NPI | 1588738793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 13911) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: GA LPC003382) |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2020-11-04 |