| NPI | 1356170856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0015305) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WY LPC-2061) |
| Enumeration Date | 2024-08-01 |
| Last Update Date | 2024-08-01 |