| NPI | 1730463480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WY LPC - 1246) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WY LPC-1246) |
| 101Y00000X Counselor (Licence: WY PPC-546) | |
| Enumeration Date | 2011-09-29 |
| Last Update Date | 2017-05-03 |