| NPI | 1992033807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA RC00049399) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WA HP10001380) |
| Enumeration Date | 2009-12-03 |
| Last Update Date | 2009-12-03 |