| NPI | 1215082714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA 60289923) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA 60289917) |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2017-05-10 |