| NPI | 1821565789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA SC61090670) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP6025028) |
| Enumeration Date | 2018-10-30 |
| Last Update Date | 2023-09-19 |