| NPI | 1336656990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CG60708168) |
| Enumeration Date | 2018-01-04 |
| Last Update Date | 2018-01-11 |