| NPI | 1174636500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP60721362) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH00007704) |
| 103TC0700X Psychologist, Clinical (Licence: CA 2012832) | |
| 101YP2500X Counselor, Professional (Licence: WA LH0007704) | |
| 103TC0700X Psychologist, Clinical (Licence: WA LH00007704) | |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2021-06-24 |