| NPI | 1568640639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA RC00014788) |
| Additional Taxonomies | 376K00000X Nurse's Aide (Licence: WA NA00094615) |
| Enumeration Date | 2008-01-31 |
| Last Update Date | 2008-01-31 |