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Individual
KAHLIL ETHAN WILSON-MOORE
Active
Individual
KAHLIL ETHAN WILSON-MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
GC61187844
WA
175T00000X
Peer Specialist
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/04/2021
Last updated
06/24/2021
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