| NPI | 1003382409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP00000646) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: WA CP00000646) |
| Enumeration Date | 2018-10-23 |
| Last Update Date | 2023-10-16 |