| NPI | 1164154910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: WA CG61331921) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA MC70005368) |
| Enumeration Date | 2022-06-29 |
| Last Update Date | 2025-09-11 |