| NPI | 1780878694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP00004360) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA RC00025859) |
| Enumeration Date | 2007-09-04 |
| Last Update Date | 2007-09-04 |