| NPI | 1841774452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP60213201) |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2018-09-19 |
| Last Update Date | 2021-06-29 |