| NPI | 1104950351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA CG60126561) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP00000291) |
| 101YM0800X Counselor, Mental Health (Licence: WA RC00030495) | |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2011-03-17 |