NPI | 1376698076 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WY LPC 372) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WY LAT138) |
101YP2500X Counselor, Professional (Licence: NCC31988) | |
Enumeration Date | 2007-01-24 |
Last Update Date | 2007-07-08 |