| NPI | 1205305935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA MC60582897) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CO60582293) |
| 101YM0800X Counselor, Mental Health (Licence: WA MC60582897) | |
| Enumeration Date | 2018-11-26 |
| Last Update Date | 2018-12-19 |