| NPI | 1871140590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP000006387) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CG60997138) |
| Enumeration Date | 2019-08-19 |
| Last Update Date | 2020-11-17 |