| NPI | 1407005721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA RC00053032) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| Enumeration Date | 2008-09-10 |
| Last Update Date | 2011-05-11 |