| NPI | 1083222434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: WA CO61026236) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA CO61026236) | |
| Enumeration Date | 2020-07-21 |
| Last Update Date | 2023-02-28 |