| NPI | 1477022440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: WA CG60273952) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CG60273952) |
| Enumeration Date | 2018-11-19 |
| Last Update Date | 2021-04-09 |