| NPI | 1033954938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: WA CO61540890) |
| Enumeration Date | 2024-07-01 |
| Last Update Date | 2024-07-01 |