| NPI | 1063887198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA SC 60588857) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CO 60610826) |
| Enumeration Date | 2015-12-01 |
| Last Update Date | 2015-12-01 |