| NPI | 1659590057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: GA LPC007208) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH8247) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2015-06-01 |