| NPI | 1912017153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA RC00017014) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP00002230) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2015-09-29 |