| NPI | 1225460850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH60324713) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP60298435) |
| 101Y00000X Counselor (Licence: WA LH60324713) | |
| Enumeration Date | 2013-08-06 |
| Last Update Date | 2022-11-04 |