| NPI | 1609991231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA CP00006170) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA RC00044915) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2023-09-07 |