| NPI | 1154948685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: WA GRAHAJB051KE) |
| Enumeration Date | 2020-06-30 |
| Last Update Date | 2020-08-28 |