| NPI | 1881163202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CP610863202) |
| Additional Taxonomies | 376K00000X Nurse's Aide |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA CO60898121) | |
| Enumeration Date | 2018-11-14 |
| Last Update Date | 2022-09-16 |