| NPI | 1386825446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WY LPC-550) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WY LAT-220) |
| 101YM0800X Counselor, Mental Health (Licence: ID LCPC3048) | |
| Enumeration Date | 2007-11-16 |
| Last Update Date | 2015-12-14 |