| NPI | 1871859967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC008084) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: GA APC003325) |
| Enumeration Date | 2012-04-03 |
| Last Update Date | 2022-03-07 |