| NPI | 1013251008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA CG61485099) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: WA CG61485099) |
| 225700000X Massage Therapist (Licence: WA MA 60240938) | |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2024-04-11 |