| NPI | 1790925949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC004916) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: GA 004916) |
| 101YP2500X Counselor, Professional (Licence: CO 418) | |
| Enumeration Date | 2009-03-01 |
| Last Update Date | 2009-04-02 |