| NPI | 1407554660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP61653011) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: WA CGCG61413793) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-02-17 |
| Last Update Date | 2025-04-10 |