| NPI | 1053059022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KS LCPC04290) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WY LPC-2323) |
| Enumeration Date | 2022-05-20 |
| Last Update Date | 2026-06-18 |