| NPI | 1285174771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA LF61228291) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CG60966864) |
| Enumeration Date | 2017-03-02 |
| Last Update Date | 2023-04-26 |