| NPI | 1730221839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA 4374) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 45247) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA 4169) | |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2024-03-21 |