| NPI | 1407390321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CG60687270) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CG60687270) |
| Enumeration Date | 2016-12-12 |
| Last Update Date | 2016-12-12 |