| NPI | 1639221047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA 00004147) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH00010791) |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2021-11-23 |