| NPI | 1861086241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: WA CG61163067) |
| Additional Taxonomies | 101Y00000X Counselor |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2021-02-25 |
| Last Update Date | 2022-01-06 |