| NPI | 1043640873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR C3832) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 10-12-53) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA 60407047) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA 60801992) | |
| Enumeration Date | 2013-11-14 |
| Last Update Date | 2019-01-18 |