| NPI | 1568726040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA LH60512309) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO 5814) |
| Enumeration Date | 2012-06-28 |
| Last Update Date | 2016-12-07 |