| NPI | 1467673194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WY LPC-1374) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NE 2775) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2014-04-08 |