| NPI | 1720257215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA 020703-lh00005453) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA 20000262) |
| 106H00000X Marriage & Family Therapist (Licence: WA 020705-ff00001053) | |
| Enumeration Date | 2008-02-28 |
| Last Update Date | 2011-03-22 |