| NPI | 1225005119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: WA CG60143557) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WA CG60143557) |
| Enumeration Date | 2006-03-01 |
| Last Update Date | 2022-04-04 |