| NPI | 1902089980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP60142281) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA RC00055523) |
| Enumeration Date | 2007-12-12 |
| Last Update Date | 2024-12-31 |