| NPI | 1457879710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: SD LPC-MH20391) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: SD LPC20348) |
| Enumeration Date | 2017-09-06 |
| Last Update Date | 2022-06-13 |