| NPI | 1629503248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: GA LPC007196) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: GA LPC007196) |
| 101YP2500X Counselor, Professional (Licence: GA LPC007196) | |
| Enumeration Date | 2017-04-21 |
| Last Update Date | 2019-02-26 |