| NPI | 1891221131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: WA CP00004289) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: WA CG61359572) |
| Enumeration Date | 2017-05-05 |
| Last Update Date | 2022-12-07 |