| NPI | 1871990960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: WA CO60296048) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CG 60552484) |
| Enumeration Date | 2014-12-04 |
| Last Update Date | 2015-07-14 |