| NPI | 1124558614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP61249696) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CO60906258) |
| 101Y00000X Counselor (Licence: WA CG60475258) | |
| Enumeration Date | 2017-06-15 |
| Last Update Date | 2023-06-29 |