NPI | 1699218982 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC008876) |
Additional Taxonomies | 101Y00000X Counselor (Licence: GA LPC008876) |
Enumeration Date | 2016-11-18 |
Last Update Date | 2020-11-03 |