| NPI | 1255529665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA CP00006432) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA RC00043141) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP00006432) | |
| Enumeration Date | 2007-10-10 |
| Last Update Date | 2015-06-17 |