| NPI | 1902186711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WY LPC-1322) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WY Wyoming PPC #534) |
| Enumeration Date | 2011-08-24 |
| Last Update Date | 2014-06-24 |