| NPI | 1700466232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA CG61138660) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: WA CG61138660) |
| Enumeration Date | 2021-04-09 |
| Last Update Date | 2021-04-23 |