| NPI | 1073940250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WY LPC-1503) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 6401013055) |
| Enumeration Date | 2013-10-02 |
| Last Update Date | 2015-08-06 |