NPI | 1568660330 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101Y00000X Counselor (Licence: WA RC00053261) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP00006219) |
Enumeration Date | 2007-07-03 |
Last Update Date | 2007-07-08 |