| NPI | 1093088262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA SA 60471715) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP 00006028) |
| Enumeration Date | 2012-02-17 |
| Last Update Date | 2016-07-07 |