| NPI | 1386877389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP-00001417) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA RC-00018500) |
| Enumeration Date | 2009-08-25 |
| Last Update Date | 2009-08-25 |