| NPI | 1568505824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA MC61017625) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH C.0600141) |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2022-10-25 |