| NPI | 1932452349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WY LPC-1435) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: ID 5008) |
| Enumeration Date | 2012-10-23 |
| Last Update Date | 2018-03-17 |