| NPI | 1497318067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: WA 60801682) |
| Enumeration Date | 2019-04-18 |
| Last Update Date | 2020-01-20 |