| NPI | 1821564865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: GA LPC013736) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WI 7088-125) |
| Enumeration Date | 2018-10-17 |
| Last Update Date | 2023-07-11 |