| NPI | 1164168209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP00003660) |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: WA CU61619384) |
| Enumeration Date | 2022-05-11 |
| Last Update Date | 2026-01-27 |