| NPI | 1578976536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA CG60213459) |
| Additional Taxonomies | 376K00000X Nurse's Aide (Licence: WA NC60138984) |
| Enumeration Date | 2014-06-08 |
| Last Update Date | 2014-06-08 |