| NPI | 1407249063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA MC60593925) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 15-07-2-1) |
| 101YM0800X Counselor, Mental Health (Licence: CA 10311) | |
| 101Y00000X Counselor | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-03-06 |
| Last Update Date | 2024-11-22 |