| NPI | 1659134690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA 61498783) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA 61512729) |
| Enumeration Date | 2024-02-02 |
| Last Update Date | 2024-03-15 |