| NPI | 1255694758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP60437230) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CO60265245) |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2019-03-20 |