| NPI | 1093111585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: WA CO60166232) |
| 1041C0700X Social Worker Clinical (Licence: WA SC60258191) | |
| Enumeration Date | 2014-11-10 |
| Last Update Date | 2022-12-05 |