| NPI | 1952433039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WA LH00010656) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: WA CO60923282) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: WA CP61105100) | |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2021-05-26 |