| NPI | 1841544939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC008540) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: GA APC003619) |
| Enumeration Date | 2012-10-29 |
| Last Update Date | 2015-08-11 |