| NPI | 1396080917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WY LPC-1434) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WY PPC721) |
| Enumeration Date | 2012-12-07 |
| Last Update Date | 2019-07-09 |