| NPI | 1831470004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WY LPC-1291) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WY 549) |
| 101YP2500X Counselor, Professional (Licence: WY LPC-1291) | |
| 101YM0800X Counselor, Mental Health (Licence: WY LPC-1291) | |
| Enumeration Date | 2011-09-01 |
| Last Update Date | 2012-08-13 |