| NPI | 1952773137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH61292084) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 19-10-11) |
| 101YM0800X Counselor, Mental Health (Licence: OR C5602) | |
| Enumeration Date | 2015-10-27 |
| Last Update Date | 2024-05-13 |