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 |