| NPI | 1639304298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0013650) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: GA 7414) |
| 101YM0800X Counselor, Mental Health (Licence: FL 10246) | |
| 101YP2500X Counselor, Professional (Licence: TN 2466) | |
| 101YP2500X Counselor, Professional (Licence: GA 7414) | |
| Enumeration Date | 2009-05-26 |
| Last Update Date | 2023-11-13 |