| NPI | 1639571516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: WA CP00002267) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: WA CG60238245) |
| 101YP2500X Counselor Professional (Licence: WA LH60106782) | |
| Enumeration Date | 2014-09-22 |
| Last Update Date | 2022-07-21 |