| NPI | 1730613290 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 12847) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: GA LPC012465) |
| 101YP2500X Counselor, Professional (Licence: SC LPC.7467) | |
| Enumeration Date | 2017-04-11 |
| Last Update Date | 2024-05-14 |