| NPI | 1790158558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: SD LPC-MH30513) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: SD LPC20325) |
| 101YP2500X Counselor, Professional (Licence: SD LPC-MH30513) | |
| Enumeration Date | 2015-11-02 |
| Last Update Date | 2022-04-07 |