| NPI | 1669943668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC013092) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: SC LPC.9188) |
| 101YP2500X Counselor, Professional (Licence: AL LPC03992) | |
| Enumeration Date | 2018-12-17 |
| Last Update Date | 2023-11-29 |