| NPI | 1376866491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WY PPC-512) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WY PPC-512) |
| Enumeration Date | 2010-03-03 |
| Last Update Date | 2010-03-03 |