| NPI | 1568940211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WY LPC-2038) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WY LAT-404) |
| 101YM0800X Counselor, Mental Health (Licence: WY LPC-2038) | |
| Enumeration Date | 2018-08-03 |
| Last Update Date | 2024-08-07 |