| NPI | 1821563735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC012032) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: GA APC006444) |
| Enumeration Date | 2018-10-06 |
| Last Update Date | 2022-03-12 |