| NPI | 1619582871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: WA CG61097214) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: WA CG61097214) |
| Enumeration Date | 2020-09-14 |
| Last Update Date | 2020-09-14 |