| NPI | 1790299097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251S00000X (Licence: WY LPC-1609) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WY 1609) |
| Enumeration Date | 2017-11-22 |
| Last Update Date | 2018-03-28 |