| NPI | 1275018483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WI 4828-226) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 19320-130) |
| 171M00000X Case Manager/Care Coordinator (Licence: WA 60513129) | |
| Enumeration Date | 2018-10-03 |
| Last Update Date | 2021-01-21 |