| NPI | 1386368397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 229N00000X Anaplastologist (Licence: WA CO61358694) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 221700000X Art Therapist (Licence: WA CO61358694) | |
| Enumeration Date | 2022-10-03 |
| Last Update Date | 2024-07-16 |