| NPI | 1194450841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA CO61260470) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: WA CG61436039) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: WA CP61550600) | |
| Enumeration Date | 2022-07-18 |
| Last Update Date | 2024-06-24 |