| NPI | 1750929030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 88702) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WY PPC-1109) |
| 101YP2500X Counselor, Professional (Licence: CO LPC.0017183) | |
| 101YP2500X Counselor, Professional (Licence: WY LPC-2015) | |
| Enumeration Date | 2019-12-17 |
| Last Update Date | 2023-02-13 |