| NPI | 1841581733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR C3328) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 09R24) |
| 101YM0800X Counselor, Mental Health (Licence: WA LH60341539) | |
| Enumeration Date | 2011-04-26 |
| Last Update Date | 2017-01-26 |