| NPI | 1356673297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WY LPC-1831) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WY PPC-766) |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2010-02-03 |
| Last Update Date | 2022-09-08 |