| NPI | 1750361358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WA RC00048282) |
| Additional Taxonomies | 104100000X Social Worker (Licence: TX 22887) |
| 376K00000X Nurse's Aide (Licence: WA NC10088127) | |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2007-07-08 |