| NPI | 1447717632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA 60914553) |
| Enumeration Date | 2019-02-25 |
| Last Update Date | 2019-11-22 |