| NPI | 1184192478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: WA CP60235869) |
| Additional Taxonomies | 376K00000X Nurse's Aide (Licence: WA NC10053032) |
| Enumeration Date | 2018-11-05 |
| Last Update Date | 2018-11-06 |