| NPI | 1346679099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA MC60299211) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CO60422044) |
| Enumeration Date | 2013-11-04 |
| Last Update Date | 2013-11-04 |