| NPI | 1598706749 |
|---|---|
| Other Name | DAVE JETSON |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: SD LPC-MH2145) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: SD LPC-MH2145) |
| 101YP2500X Counselor, Professional (Licence: SD LPC-MH2145) | |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2021-06-03 |