| NPI | 1124660709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA CG61007929) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA NA60934465) |
| Enumeration Date | 2019-10-15 |
| Last Update Date | 2023-09-18 |