| NPI | 1558580472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WY LPC-989) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WY LPC-989) |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2011-10-12 |