| NPI | 1063131175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP61557487) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA 61337108) |
| Enumeration Date | 2022-08-23 |
| Last Update Date | 2024-11-26 |