| NPI | 1477733277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH00003755) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: WA LP00053714) |
| Enumeration Date | 2007-11-08 |
| Last Update Date | 2007-11-08 |