| NPI | 1285002428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: WA CP60781841) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: WA CG60627295) |
| Enumeration Date | 2015-09-04 |
| Last Update Date | 2018-03-13 |