| NPI | 1548131774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: WA CG70048486) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CG70048486) |
| Enumeration Date | 2025-09-12 |
| Last Update Date | 2025-11-06 |