| NPI | 1457281412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: WA CPST.PE70111824) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CAAR.CG.70084404) |
| Enumeration Date | 2026-05-21 |
| Last Update Date | 2026-05-21 |