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 |