| NPI | 1659194546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WY LPC-2561) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO LPC-0024289) |
| Enumeration Date | 2024-11-07 |
| Last Update Date | 2026-09-03 |