| NPI | 1861662637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC3930) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: GA lpc003930) |
| Enumeration Date | 2008-03-07 |
| Last Update Date | 2011-04-07 |