| NPI | 1215302096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WA LH60626779) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA 2193) |
| Enumeration Date | 2015-12-05 |
| Last Update Date | 2024-09-11 |