| NPI | 1669745675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC003956) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: GA 1091587) |
| 103TH0100X Psychologist, Health Service (Licence: GA LPC003956) | |
| Enumeration Date | 2012-02-22 |
| Last Update Date | 2023-05-29 |