| NPI | 1871033753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: GA LPC002158) |
| Additional Taxonomies | 101YS0200X Counselor School |
| Enumeration Date | 2017-02-27 |
| Last Update Date | 2017-02-27 |