| NPI | 1790039626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: GA LPC008491) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: GA MFT001412) |
| Enumeration Date | 2012-10-30 |
| Last Update Date | 2016-12-21 |