| NPI | 1841639606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC010825) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor, Mental Health (Licence: GA APC005387) | |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2013-06-14 |
| Last Update Date | 2019-06-11 |