| NPI | 1124140629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH00004381) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WA 2966) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA 1068) | |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2018-11-27 |