| NPI | 1780079947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH60694014) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI C-02812) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP60805563) | |
| 101YM0800X Counselor, Mental Health (Licence: MI 6401014232) | |
| Enumeration Date | 2015-04-03 |
| Last Update Date | 2021-08-19 |