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 |