| NPI | 1043816960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WY LPC-2095) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WY PPC-1206) |
| 101Y00000X Counselor (Licence: WY PPC-1206) | |
| Enumeration Date | 2020-12-07 |
| Last Update Date | 2023-04-28 |