| NPI | 1124265939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WY LPC-579) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WY WY#579) |
| Enumeration Date | 2009-01-15 |
| Last Update Date | 2023-08-22 |