| NPI | 1932309762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CP00006419) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: WA CP00006419) | |
| 104100000X Social Worker | |
| Enumeration Date | 2007-07-19 |
| Last Update Date | 2013-06-13 |