| NPI | 1760334296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: WA CPST.PE.70153722) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CAAR.CG.70085864) |
| Enumeration Date | 2026-02-09 |
| Last Update Date | 2026-08-21 |