NPI | 1164148433 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101Y00000X Counselor (Licence: WA CG61370978) |
Additional Taxonomies | 175T00000X Peer Specialist (Licence: WA CG1370978) |
Enumeration Date | 2022-10-18 |
Last Update Date | 2025-09-23 |