| NPI | 1134650492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: WA LW61126878) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP60647381) |
| 104100000X Social Worker (Licence: WA SC60772738) | |
| 101Y00000X Counselor (Licence: WA SC60772738) | |
| Enumeration Date | 2017-03-27 |
| Last Update Date | 2022-02-11 |