| NPI | 1316661952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA CO61205474) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CO61205474) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA 61205474) | |
| Enumeration Date | 2022-09-27 |
| Last Update Date | 2023-03-14 |