| NPI | 1730511551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WA LH00006859) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NV CP5745-R) |
| Enumeration Date | 2013-08-02 |
| Last Update Date | 2026-03-18 |