| NPI | 1639253818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC003253) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: GA 003253) |
| 103TC1900X Psychologist, Counseling (Licence: GA LPC003253) | |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2024-08-19 |