| NPI | 1376115287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: LA WA861035) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: LA WA861035) |
| 101YP1600X Counselor, Pastoral (Licence: LA WA861035) | |
| 101Y00000X Counselor (Licence: LA WA861035) | |
| Enumeration Date | 2021-07-12 |
| Last Update Date | 2021-07-12 |