| NPI | 1932524014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW60398043) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP60370891) |
| Enumeration Date | 2014-02-25 |
| Last Update Date | 2014-10-14 |