| NPI | 1366859837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WY LPC-1815) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 178.006500) |
| Enumeration Date | 2014-07-16 |
| Last Update Date | 2020-03-16 |