| 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 |