| NPI | 1457828378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA CG60241302) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: WA CG60241302) |
| Enumeration Date | 2018-10-29 |
| Last Update Date | 2021-04-13 |