| NPI | 1710203526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WY 0125) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WY LMFT0125) |
| 101Y00000X Counselor (Licence: WY LMFT0125) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WY LMFT0125) | |
| 101YP2500X Counselor, Professional (Licence: WY LMFT0125) | |
| Enumeration Date | 2010-04-19 |
| Last Update Date | 2016-09-30 |