| NPI | 1194470013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA MC61471604) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP61461771) |
| Enumeration Date | 2022-02-18 |
| Last Update Date | 2025-01-24 |