| NPI | 1629482880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: WA CG60738009) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 372600000X Adult Companion | |
| Enumeration Date | 2014-06-16 |
| Last Update Date | 2023-08-07 |