| 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 |