| NPI | 1871586222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP00004960) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 03-R-04) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI 2-00645) | |
| 1041C0700X Social Worker, Clinical (Licence: WA LW00007884) | |
| 1041C0700X Social Worker, Clinical (Licence: OR L3386) | |
| Enumeration Date | 2005-08-31 |
| Last Update Date | 2013-06-12 |