| NPI | 1730695735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA 4316) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: GA LPC008425) |
| Enumeration Date | 2017-12-28 |
| Last Update Date | 2022-07-21 |