| NPI | 1427526276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: WA CG60531421) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CG60531421) |
| Enumeration Date | 2018-11-09 |
| Last Update Date | 2020-02-05 |