NPI | 1932566643 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WY LPC-860) |
Additional Taxonomies | 101YS0200X Counselor, School (Licence: WY Standard) |
103TS0200X Psychologist, School (Licence: WY Standard) | |
Enumeration Date | 2016-01-26 |
Last Update Date | 2016-01-26 |