| NPI | 1164565750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH60146267) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA LH60146267) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2022-11-08 |