| NPI | 1528236999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WA RC00036054) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: WA CP00004098) |
| Enumeration Date | 2008-02-19 |
| Last Update Date | 2008-02-19 |