| NPI | 1952781239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC009670) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MS 1970) |
| Enumeration Date | 2015-06-02 |
| Last Update Date | 2018-10-03 |