| NPI | 1609059625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: WA RC 00059783) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA A0222 WA ST. L&I) |
| Enumeration Date | 2007-12-12 |
| Last Update Date | 2007-12-12 |