| NPI | 1710160320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC006095) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: GA APC001620) |
| Enumeration Date | 2007-12-06 |
| Last Update Date | 2022-09-21 |