| NPI | 1104510155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CG61448910) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-06-05 |
| Last Update Date | 2023-10-03 |