| NPI | 1265902282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA CG60761232) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: WA CG60761232) |
| Enumeration Date | 2018-12-03 |
| Last Update Date | 2020-11-17 |