| NPI | 1285002428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW61677859) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP60781841) |
| 101YM0800X Counselor, Mental Health (Licence: WA CG60627295) | |
| Enumeration Date | 2015-09-04 |
| Last Update Date | 2025-06-25 |