| NPI | 1265785695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: WA LW60530862) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP60544158) |
| Enumeration Date | 2012-10-23 |
| Last Update Date | 2016-03-31 |