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 |