| NPI | 1821460528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: WY LPC-1305) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: UT 7405332-6004) |
| Enumeration Date | 2015-10-21 |
| Last Update Date | 2020-05-08 |