| NPI | 1972943090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ID LPC7663) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CL60200343) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA 507297) | |
| Enumeration Date | 2013-07-03 |
| Last Update Date | 2020-12-29 |