| NPI | 1043904386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA MC61540091) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 101Y00000X Counselor | |
| Enumeration Date | 2023-06-08 |
| Last Update Date | 2024-07-08 |