| NPI | 1093286221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: WA CG-60851809) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2018-12-16 |
| Last Update Date | 2019-07-11 |