| NPI | 1154765501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WY LPC-1582) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WY LAT-362) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO 0000312) | |
| 101YM0800X Counselor, Mental Health (Licence: CO 0012078) | |
| Enumeration Date | 2013-04-28 |
| Last Update Date | 2020-09-14 |