| NPI | 1033884945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA CG61213925) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 175T00000X Peer Specialist (Licence: WA 1033884945) | |
| Enumeration Date | 2021-08-12 |
| Last Update Date | 2021-10-14 |