| NPI | 1629444351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WY LPC-1744) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WY PPC) |
| Enumeration Date | 2015-08-17 |
| Last Update Date | 2023-12-11 |