| NPI | 1891078291 |
|---|---|
| Former Name | IRIS LEE BLEDSOE |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH60514070) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA NA00175153) |
| Enumeration Date | 2011-09-21 |
| Last Update Date | 2016-07-28 |