| NPI | 1144580432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH60930372) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CO 60158865) |
| 2083A0300X Preventive Medicine, Addiction Medicine (Licence: PA 7889) | |
| Enumeration Date | 2012-05-21 |
| Last Update Date | 2019-07-09 |