| NPI | 1811315997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WY LPC-1945) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WY PPC-1065) |
| Enumeration Date | 2014-04-04 |
| Last Update Date | 2021-04-20 |