| NPI | 1104606094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP61491980) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA MC70075130) |
| Enumeration Date | 2023-09-29 |
| Last Update Date | 2025-12-18 |