| NPI | 1922215102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA RC00041198) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP00005051) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2007-07-08 |