| NPI | 1407913312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WA RC00047877) |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2026-05-31 |