| NPI | 1659520161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC009418) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2008-09-09 |
| Last Update Date | 2024-07-05 |