| NPI | 1154687465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WY LPC-1410) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO NLC-13914) |
| Enumeration Date | 2012-04-11 |
| Last Update Date | 2015-04-07 |