| NPI | 1518404110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: WA CG60638577) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CG60638577) |
| Enumeration Date | 2017-01-21 |
| Last Update Date | 2020-08-04 |