| NPI | 1013184225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP60080428) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA CG60149282) |
| 101Y00000X Counselor (Licence: WA CG60149282) | |
| Enumeration Date | 2008-05-15 |
| Last Update Date | 2013-03-25 |