| NPI | 1780747477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WY lpc 888) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WY lpc888) |
| 101Y00000X Counselor | |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2011-06-29 |