| NPI | 1952463234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA CG60142038) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP 00002940) |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2026-08-19 |