| NPI | 1962947499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: SC 7175) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: GA LPC008834) |
| 103TC1900X Psychologist, Counseling | |
| Enumeration Date | 2016-12-19 |
| Last Update Date | 2019-11-22 |