| NPI | 1811289929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC003569) |
| Additional Taxonomies | 101YS0200X Counselor, School |
| Enumeration Date | 2011-05-07 |
| Last Update Date | 2011-05-07 |