| NPI | 1376034199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CDPT.CO.60817757) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA 60817757) |
| Enumeration Date | 2018-05-29 |
| Last Update Date | 2018-05-29 |