| NPI | 1174025324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WY LPC-1895) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: ID LCPC-8310) |
| 101YP2500X Counselor, Professional (Licence: UT 13050268-6004) | |
| Enumeration Date | 2018-03-04 |
| Last Update Date | 2024-06-20 |