| NPI | 1821552266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AZ LASAC-7186T) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP60969656) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CO60703545) | |
| Enumeration Date | 2019-01-30 |
| Last Update Date | 2022-03-01 |