| NPI | 1770714222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP 00006204) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA RC 00053150) |
| Enumeration Date | 2009-07-31 |
| Last Update Date | 2009-07-31 |