| NPI | 1699109082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CO60402125) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA CG60314589) |
| Enumeration Date | 2013-08-21 |
| Last Update Date | 2013-08-21 |