| NPI | 1275830705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WY LPC-1617) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WY lpc-1617) |
| Enumeration Date | 2011-02-18 |
| Last Update Date | 2021-01-06 |