| NPI | 1851601538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA cp00004681) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WA cg60175085) |
| Enumeration Date | 2010-10-15 |
| Last Update Date | 2010-10-15 |