| NPI | 1043084833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WY LPC-2149) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: PA PC013951) |
| Enumeration Date | 2023-11-13 |
| Last Update Date | 2023-11-13 |