| NPI | 1518420298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CG61585142) |
| Enumeration Date | 2019-04-10 |
| Last Update Date | 2024-10-07 |