| NPI | 1689985913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: WA CP60720050) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CG60116071) |
| Enumeration Date | 2010-07-01 |
| Last Update Date | 2023-07-11 |