| NPI | 1477551687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WY LPC-685) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WY LPC-685) |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2024-04-11 |