| NPI | 1922501998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: WA CO60881922) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: WA BHA.FS.61435115) |
| Enumeration Date | 2018-03-15 |
| Last Update Date | 2023-11-22 |