| NPI | 1548068471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA CO70054759) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CG70064520) |
| Enumeration Date | 2025-03-06 |
| Last Update Date | 2025-11-14 |