| NPI | 1396846879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WY LPC-804) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WY LPC804) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2016-09-06 |