| NPI | 1023737152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: WY LPC-2377) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WY PPC-1344) |
| Enumeration Date | 2022-08-23 |
| Last Update Date | 2025-01-21 |