| NPI | 1801614292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: WA CG61441299) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA CG61441299) |
| Enumeration Date | 2024-10-02 |
| Last Update Date | 2024-10-25 |