NPI | 1659926418 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101Y00000X Counselor (Licence: WA MG61439951) |
Additional Taxonomies | 175T00000X Peer Specialist (Licence: WA CG60992449) |
Enumeration Date | 2019-08-07 |
Last Update Date | 2023-09-06 |