| NPI | 1710534425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA 1710534425) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 171M00000X Case Manager/Care Coordinator | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA 60549425) | |
| Enumeration Date | 2019-08-19 |
| Last Update Date | 2026-08-18 |