| NPI | 1215346747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WY PPC-1555) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 26854) |
| Enumeration Date | 2014-08-08 |
| Last Update Date | 2025-06-16 |