| NPI | 1083182802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: ID 2961173) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CG60819606) |
| Enumeration Date | 2018-11-09 |
| Last Update Date | 2024-12-09 |