| NPI | 1891070108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: SC 5317) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC 20804) |
| 101YP2500X Counselor, Professional (Licence: GA LPC010624) | |
| Enumeration Date | 2011-10-18 |
| Last Update Date | 2025-01-16 |