| NPI | 1154868347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA 00004542) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP00004542) |
| 101YM0800X Counselor, Mental Health (Licence: WA 00004542) | |
| Enumeration Date | 2017-01-25 |
| Last Update Date | 2020-08-11 |