| NPI | 1043491160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP60020548) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: WA CG60149871) |
| 101Y00000X Counselor (Licence: WA CG60149871) | |
| Enumeration Date | 2007-11-16 |
| Last Update Date | 2013-03-22 |