| NPI | 1215784913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA SC61602278) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CO61470170) |
| Enumeration Date | 2024-05-01 |
| Last Update Date | 2024-12-11 |