| NPI | 1598956344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC005550) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH 8417) |
| Enumeration Date | 2007-08-07 |
| Last Update Date | 2009-06-16 |