| NPI | 1568959542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA 60779774) |
| Enumeration Date | 2018-04-16 |
| Last Update Date | 2021-09-24 |