| NPI | 1770361685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA 61504588) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA 61618751) |
| Enumeration Date | 2023-09-20 |
| Last Update Date | 2025-05-24 |