| NPI | 1720785983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC014547) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: GA APC007538) |
| Enumeration Date | 2023-02-08 |
| Last Update Date | 2024-02-19 |