| NPI | 1679549844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP00003902) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WA LH00006769) |
| Enumeration Date | 2006-02-27 |
| Last Update Date | 2007-07-08 |