NPI | 1497028823 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA CU61584983) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA CL60461451) |
101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP00001663) | |
Enumeration Date | 2012-02-15 |
Last Update Date | 2025-07-12 |