| NPI | 1659591352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR c5702) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WA LH60807650) |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2024-12-05 |