| NPI | 1679143101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CO61411196) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WA CG61243705) |
| 175T00000X Peer Specialist | |
| Enumeration Date | 2021-06-28 |
| Last Update Date | 2023-08-18 |