| NPI | 1144798034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA CG60416561) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA peer) |
| 101Y00000X Counselor | |
| Enumeration Date | 2018-11-08 |
| Last Update Date | 2024-07-16 |