NPI | 1538909932 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 175T00000X Peer Specialist |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CO61560324) |
Enumeration Date | 2024-05-31 |
Last Update Date | 2025-07-17 |