| NPI | 1538456231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WY LPC-1829) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MO 2011014540) |
| Enumeration Date | 2011-07-01 |
| Last Update Date | 2024-01-24 |