| NPI | 1295929271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP00004660) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA SC60160699) |
| 1041C0700X Social Worker, Clinical (Licence: WA LW60475335) | |
| Enumeration Date | 2007-08-31 |
| Last Update Date | 2015-03-25 |