| NPI | 1164768859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CG60157307) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: WA CG60157307) |
| Enumeration Date | 2012-12-27 |
| Last Update Date | 2012-12-27 |