| NPI | 1841665502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: WA 60600303) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA cg600303) |
| Enumeration Date | 2015-12-07 |
| Last Update Date | 2019-04-08 |