| NPI | 1831494400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA CG60130541) |
| Additional Taxonomies | 376K00000X Nurse's Aide (Licence: WA NA00197940) |
| Enumeration Date | 2011-01-12 |
| Last Update Date | 2011-01-12 |