| NPI | 1972976199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH60840470) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA MC 60644116) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CO 60569345) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP60712530) | |
| Enumeration Date | 2015-11-10 |
| Last Update Date | 2023-04-11 |