| NPI | 1982981353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: GA LPC007943) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: GA APC002981) |
| Enumeration Date | 2011-11-13 |
| Last Update Date | 2020-08-13 |