NPI | 1295121291 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101Y00000X Counselor (Licence: OR C5976) |
Additional Taxonomies | 101Y00000X Counselor (Licence: WA MC60169539) |
Enumeration Date | 2015-04-07 |
Last Update Date | 2023-09-07 |