| NPI | 1396140133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA 60493676) |
| Enumeration Date | 2014-10-22 |
| Last Update Date | 2019-03-20 |