| NPI | 1770362683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: WA CO61510445) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: WA MC61642653) |
| Enumeration Date | 2023-09-28 |
| Last Update Date | 2025-07-24 |