| NPI | 1093516858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA CAAR.CG.70012997) |
| Additional Taxonomies | 376K00000X Nurse's Aide (Licence: WA NAC.NC.61634182) |
| Enumeration Date | 2025-03-19 |
| Last Update Date | 2026-08-10 |