| NPI | 1083751416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WY LP423) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WY psychologist 423) |
| 101YP2500X Counselor, Professional (Licence: WY lmft 53) | |
| 101YP2500X Counselor, Professional (Licence: WY LPC 346) | |
| 103TC0700X Psychologist, Clinical (Licence: WY LPC346) | |
| 103TC0700X Psychologist, Clinical (Licence: WY LMFT53) | |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2023-02-08 |