| NPI | 1578949012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP00000105) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH00006881) |
| Enumeration Date | 2015-08-06 |
| Last Update Date | 2015-08-06 |