| NPI | 1134528599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CO60178687) |
| 101YM0800X Counselor Mental Health | |
| Enumeration Date | 2014-08-21 |
| Last Update Date | 2014-08-21 |