| NPI | 1336308121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WA RC00048134) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA RC00048134) |
| Enumeration Date | 2008-06-05 |
| Last Update Date | 2008-10-16 |