| NPI | 1174047690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA CP60494259) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OR 16-R-56) |
| Enumeration Date | 2017-07-26 |
| Last Update Date | 2017-07-26 |