| NPI | 1346864352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: WA CG61067694) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CG61067694) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-06-04 |
| Last Update Date | 2024-07-10 |