| NPI | 1265844815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WY LPC-1544) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WY PPC 830) |
| 101YP2500X Counselor, Professional (Licence: WY LPC-1544) | |
| Enumeration Date | 2014-05-29 |
| Last Update Date | 2022-07-20 |