| NPI | 1699119115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WA LH 60074511) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: WA CP 60039687) |
| Enumeration Date | 2013-04-26 |
| Last Update Date | 2017-03-28 |