| 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 |