| NPI | 1285847889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR C1790) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP60012185) |
| 101YM0800X Counselor, Mental Health (Licence: WA LH00011227) | |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2025-12-12 |