| NPI | 1184001075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WA LH00004568) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: UT 311729-6006) |
| Enumeration Date | 2015-04-30 |
| Last Update Date | 2015-05-11 |