| NPI | 1487188215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA MC61591075) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA 60664764) |
| Enumeration Date | 2017-04-19 |
| Last Update Date | 2025-04-08 |