| NPI | 1528818119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP70081055) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CO61532799) |
| Enumeration Date | 2024-03-25 |
| Last Update Date | 2026-03-09 |