| NPI | 1982065975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CG 60135538) |
| 376K00000X Nurse's Aide (Licence: WA NA 00172315) | |
| Enumeration Date | 2016-03-17 |
| Last Update Date | 2018-12-13 |