| NPI | 1265988349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP60848399) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA MC61475302) |
| Enumeration Date | 2016-08-29 |
| Last Update Date | 2024-01-03 |