| NPI | 1528604733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: WA CPSS.PR.70118355) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CAAR.CG.60980011) |
| Enumeration Date | 2019-11-22 |
| Last Update Date | 2026-08-05 |