| NPI | 1124728506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA 61411913) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: WA 61411913) |
| Enumeration Date | 2023-03-06 |
| Last Update Date | 2023-03-06 |