| NPI | 1356700447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP00001868) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CG61373475) |
| Enumeration Date | 2016-02-17 |
| Last Update Date | 2023-01-03 |