| NPI | 1497232060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP61099597) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: WA CG60783169) |
| 175T00000X Peer Specialist | |
| Enumeration Date | 2018-07-25 |
| Last Update Date | 2020-11-13 |