| NPI | 1033512744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA MHC.LH.60814298) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CDP.CP.60814286) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MT BBH-LAC-LIC-2637) | |
| 101YM0800X Counselor, Mental Health (Licence: MT BBH-LCPC-LIC-24040) | |
| Enumeration Date | 2014-10-08 |
| Last Update Date | 2018-03-22 |