| NPI | 1275210452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 101Y00000X Counselor (Licence: WA CG61470797) | |
| Enumeration Date | 2023-06-29 |
| Last Update Date | 2023-10-10 |