| NPI | 1962285536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA APC008138) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: GA LPC015114) |
| Enumeration Date | 2023-08-16 |
| Last Update Date | 2025-03-19 |