| NPI | 1689119216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC010383) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: GA APC005016) |
| Enumeration Date | 2017-01-06 |
| Last Update Date | 2023-03-10 |