| NPI | 1629583471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC007406) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA LPC308) |
| 225C00000X Rehabilitation Counselor (Licence: CA 108223) | |
| 225C00000X Rehabilitation Counselor (Licence: GA 108223) | |
| Enumeration Date | 2017-12-01 |
| Last Update Date | 2017-12-01 |