| NPI | 1770875007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA MC60323889) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP60310567) |
| 101Y00000X Counselor (Licence: WA MC60323889) | |
| Enumeration Date | 2011-05-04 |
| Last Update Date | 2013-03-21 |