| NPI | 1982853891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WY LPC-983) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WY 983) |
| Enumeration Date | 2008-09-16 |
| Last Update Date | 2017-05-01 |