| NPI | 1407987175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP00001414) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH00006812) |
| 101YM0800X Counselor, Mental Health (Licence: ID LPC-P-146) | |
| 101YM0800X Counselor, Mental Health (Licence: CO 467) | |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2007-07-08 |