| NPI | 1063103331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA CG61446393) |
| Additional Taxonomies | 175T00000X Peer Specialist |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-05-17 |
| Last Update Date | 2023-09-06 |