| NPI | 1013487727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: WA CP0000272) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: WA LH60713496) |
| Enumeration Date | 2018-11-26 |
| Last Update Date | 2018-11-26 |