| NPI | 1669941035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: GA LPC010234) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: GA LPC010234) |
| Enumeration Date | 2018-11-15 |
| Last Update Date | 2023-11-21 |