| NPI | 1255831392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO lpc.0019043) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WY LPC-1872) |
| Enumeration Date | 2018-02-15 |
| Last Update Date | 2023-07-17 |