| NPI | 1982268629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: GA LPC010040) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2019-04-29 |
| Last Update Date | 2024-01-22 |