| NPI | 1376323253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: WA CPSS.PR.70048849) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CAAR.CG.61491923) |
| Enumeration Date | 2023-09-29 |
| Last Update Date | 2026-03-03 |