| NPI | 1912528043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA 61034537) |
| Enumeration Date | 2020-04-29 |
| Last Update Date | 2022-09-16 |