| NPI | 1316412935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA SC61417289) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA co60844073) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP61367371) | |
| Enumeration Date | 2018-10-10 |
| Last Update Date | 2023-08-18 |