| NPI | 1720220072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WY LPC-087) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WY LPC-087) |
| Enumeration Date | 2009-04-01 |
| Last Update Date | 2012-05-24 |