| NPI | 1255717229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CG60131674) |
| Enumeration Date | 2015-07-31 |
| Last Update Date | 2019-02-06 |