| NPI | 1104950351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA CQ61663068) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP00000291) |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2025-03-24 |