| NPI | 1538302054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WA CL60147106) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CL60147106) | |
| Enumeration Date | 2009-04-14 |
| Last Update Date | 2023-05-19 |