| NPI | 1689902769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC005494) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: GA LPC005494) |
| 101YM0800X Counselor, Mental Health (Licence: GA LPC005494) | |
| Enumeration Date | 2009-11-30 |
| Last Update Date | 2014-06-23 |