| NPI | 1215638861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CO61552985) |
| 101Y00000X Counselor | |
| Enumeration Date | 2023-03-10 |
| Last Update Date | 2024-06-12 |