| NPI | 1376921544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP60390654) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA CG60667200) |
| Enumeration Date | 2015-05-08 |
| Last Update Date | 2017-01-10 |