| NPI | 1801435888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC009336) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MO 2007034821) |
| 101YP2500X Counselor, Professional (Licence: SC 6761) | |
| Enumeration Date | 2019-12-23 |
| Last Update Date | 2019-12-23 |