| NPI | 1699547745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CO61522834) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: CG61469435) |
| Enumeration Date | 2023-10-23 |
| Last Update Date | 2024-10-18 |