| NPI | 1215343934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WY LPC-1564) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WY PPC-834) |
| Enumeration Date | 2014-07-02 |
| Last Update Date | 2016-05-23 |