| NPI | 1023562998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA CG60672176) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: WA CG60672176) |
| Enumeration Date | 2016-08-09 |
| Last Update Date | 2020-03-09 |