| NPI | 1346916665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: WA CG61214396) |
| Enumeration Date | 2021-08-17 |
| Last Update Date | 2024-11-25 |