| NPI | 1912557091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP60345498) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WA SC60779494) |
| Enumeration Date | 2019-09-19 |
| Last Update Date | 2025-10-27 |