| NPI | 1760975908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CO60895939) |
| Additional Taxonomies | 372600000X Adult Companion |
| Enumeration Date | 2018-06-12 |
| Last Update Date | 2018-10-23 |