| NPI | 1689635849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: SD LPC 516) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: SD LMFT1066) |
| 104100000X Social Worker (Licence: SD LCSW 376) | |
| Enumeration Date | 2006-03-29 |
| Last Update Date | 2008-06-16 |