| NPI | 1700378320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA 00002033) |
| Enumeration Date | 2018-05-30 |
| Last Update Date | 2019-08-12 |