| NPI | 1225540784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA MC60771178) |
| Additional Taxonomies | 171400000X Health & Wellness Coach |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP0005749) | |
| Enumeration Date | 2017-10-24 |
| Last Update Date | 2026-03-31 |