| NPI | 1861829780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WY LPC-1376) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: SD LPC7271) |
| Enumeration Date | 2013-10-09 |
| Last Update Date | 2022-07-21 |