| NPI | 1053687137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WA0400X Registered Nurse, Addiction (Substance Use Disorder) (Licence: WA RN 00124872) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP60264607) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CO 60171745) | |
| Enumeration Date | 2012-03-22 |
| Last Update Date | 2021-07-13 |