| NPI | 1962045518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WY LPC.1803) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO LPC.14618) |
| Enumeration Date | 2019-10-25 |
| Last Update Date | 2019-10-25 |