| NPI | 1841768645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA 60765998) |
| Enumeration Date | 2018-11-09 |
| Last Update Date | 2023-04-05 |