| NPI | 1518638758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA CG61228971) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CG61228971) |
| Enumeration Date | 2021-09-27 |
| Last Update Date | 2022-02-01 |