| NPI | 1588022388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WY LPC-1963) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WY PPC-1169) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2016-02-08 |
| Last Update Date | 2021-07-04 |