| NPI | 1265058457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: OR 19-CRM-103) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OR THW000003695) |
| Enumeration Date | 2020-06-23 |
| Last Update Date | 2023-01-23 |