| NPI | 1699241679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA CG60883715) |
| Additional Taxonomies | 222Q00000X Developmental Therapist (Licence: WA CG60883715) |
| Enumeration Date | 2018-10-17 |
| Last Update Date | 2018-10-17 |