| NPI | 1952594566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: WA RC00050126) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: WA LH60520458) |
| 101YM0800X Counselor Mental Health (Licence: RC00050126) | |
| Enumeration Date | 2007-08-27 |
| Last Update Date | 2023-01-05 |