| NPI | 1275287997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA CG61581772) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: WA CO61245810) |
| Enumeration Date | 2022-02-10 |
| Last Update Date | 2024-09-18 |