| NPI | 1902463813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C6158) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WA LH61225574) |
| Enumeration Date | 2019-05-27 |
| Last Update Date | 2022-01-05 |