| NPI | 1578098711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WY LPC-725) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WY LPC-725) |
| Enumeration Date | 2017-04-25 |
| Last Update Date | 2018-05-21 |