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 |