| NPI | 1396137972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP00006115) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA MC60488888) |
| Enumeration Date | 2015-02-19 |
| Last Update Date | 2020-03-11 |