| NPI | 1023143021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA RC00056544) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2014-04-25 |