| NPI | 1073089199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA MC61508522) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP61300281) |
| Enumeration Date | 2018-10-16 |
| Last Update Date | 2025-09-04 |