| NPI | 1598526816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA CG61489051) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: WA PR70078061) |
| Enumeration Date | 2024-01-23 |
| Last Update Date | 2026-01-22 |