| NPI | 1770973307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WY LPC-1519) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NV CP0032) |
| Enumeration Date | 2015-02-04 |
| Last Update Date | 2022-10-14 |