| NPI | 1770960510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CO60548273) |
| Enumeration Date | 2015-04-30 |
| Last Update Date | 2019-05-24 |