| NPI | 1588136048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: WA CG60475423) |
| Enumeration Date | 2018-12-21 |
| Last Update Date | 2019-09-05 |