| NPI | 1164922324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WA CG61491898) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: WA C060754866) |
| 101YM0800X Counselor Mental Health | |
| Enumeration Date | 2018-02-14 |
| Last Update Date | 2024-07-22 |