NPI | 1952687568 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WY LPC-1313) |
Additional Taxonomies | 101Y00000X Counselor (Licence: WY LPC-1313) |
101YP2500X Counselor, Professional (Licence: WY PPC - 449) | |
101Y00000X Counselor (Licence: WY PPC - 449) | |
Enumeration Date | 2011-10-26 |
Last Update Date | 2018-09-27 |