| NPI | 1093010845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WA CG60199775) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CG60199775) |
| Enumeration Date | 2011-01-25 |
| Last Update Date | 2011-01-25 |