| NPI | 1417077249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: WA LW60150722) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP00001093) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2022-01-25 |