| NPI | 1205534831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CO61378037) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 175T00000X Peer Specialist | |
| Enumeration Date | 2023-02-22 |
| Last Update Date | 2023-08-03 |