| NPI | 1881037687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: WA LW60589159) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: WA CP60297760) |
| Enumeration Date | 2013-04-10 |
| Last Update Date | 2024-04-09 |