| NPI | 1992053474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WY 1198) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WY LPC-1198) |
| Enumeration Date | 2012-08-15 |
| Last Update Date | 2020-04-28 |