| NPI | 1750504247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW20951) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP00003727) |
| 101YM0800X Counselor, Mental Health (Licence: WA CG60892933) | |
| 101YP2500X Counselor, Professional (Licence: WA SC61099484) | |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2023-07-10 |