| NPI | 1588168678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA LH61418079) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AK 129756) |
| Enumeration Date | 2018-03-22 |
| Last Update Date | 2025-04-07 |