| 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 |