| NPI | 1831529395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: SC 11260) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: GA LPC007538) |
| Enumeration Date | 2013-11-20 |
| Last Update Date | 2025-08-03 |