| NPI | 1932215977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA lh00011049) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP00000241) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 95-10-15) | |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2024-08-20 |