| NPI | 1306356050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C8224) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WY LPC-2022) |
| Enumeration Date | 2017-10-09 |
| Last Update Date | 2024-05-10 |