| NPI | 1013574151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: WA 70028722) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CG60921034) |
| Enumeration Date | 2019-05-23 |
| Last Update Date | 2026-01-12 |