| NPI | 1558423749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH00008187) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP60247695) |
| 101Y00000X Counselor (Licence: WA LH00008187) | |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2013-03-20 |