| NPI | 1033686795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA 60775408) |
| Additional Taxonomies | 175T00000X Peer Specialist |
| Enumeration Date | 2018-10-30 |
| Last Update Date | 2025-05-20 |