| NPI | 1427246396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA CG60124010) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA RC pending) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP00006405) | |
| Enumeration Date | 2007-10-04 |
| Last Update Date | 2012-01-10 |