| NPI | 1942533625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA CO60120996) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA RC60086683) |
| Enumeration Date | 2009-09-11 |
| Last Update Date | 2012-11-08 |