| NPI | 1053751347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WY LPC-1745) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ID LCPC 3721) |
| Enumeration Date | 2013-07-01 |
| Last Update Date | 2018-11-08 |