| NPI | 1871374009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC014180) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 101YM0800X Counselor, Mental Health (Licence: GA LPC014180) | |
| Enumeration Date | 2023-10-12 |
| Last Update Date | 2024-01-26 |