| NPI | 1124549217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP60447997) |
| Additional Taxonomies | 101Y00000X Counselor |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2017-06-29 |
| Last Update Date | 2022-07-21 |