| NPI | 1770944498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: SD LPC-MH30556) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: SD LPC7059) |
| Enumeration Date | 2016-03-08 |
| Last Update Date | 2021-08-13 |