| NPI | 1689152142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: WA 60050044) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 101YM0800X Counselor Mental Health (Licence: WA MC60763530) | |
| Enumeration Date | 2018-08-06 |
| Last Update Date | 2025-08-12 |