| NPI | 1063047751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA LH61395696) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WA LH61395696) |
| 101YP2500X Counselor, Professional (Licence: ID LPC-7579) | |
| Enumeration Date | 2020-03-03 |
| Last Update Date | 2023-07-24 |