| NPI | 1750947941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MT LCPC-38674) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WY LPC-1778) |
| 106H00000X Marriage & Family Therapist (Licence: MT LMFT-37509) | |
| Enumeration Date | 2019-05-14 |
| Last Update Date | 2019-07-17 |