| NPI | 1083023527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WA MG 60472495) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 03-03-54) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA 60456771) | |
| Enumeration Date | 2014-08-08 |
| Last Update Date | 2014-08-08 |