| 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 |