| NPI | 1619152287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WA LH60723485) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OR C2136) |
| Enumeration Date | 2008-01-02 |
| Last Update Date | 2024-01-05 |