| NPI | 1104007269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH00005696) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP00002340) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA MAC501835) | |
| Enumeration Date | 2007-11-16 |
| Last Update Date | 2007-11-16 |