| NPI | 1912306226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC006800) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AL 3064) |
| Enumeration Date | 2014-08-22 |
| Last Update Date | 2014-08-22 |