| NPI | 1801202122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP60570726) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA CG60490938) |
| Enumeration Date | 2014-07-08 |
| Last Update Date | 2017-02-28 |