| NPI | 1639696479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CG60790952) |
| 101Y00000X Counselor | |
| 171M00000X Case Manager/Care Coordinator | |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2017-08-23 |
| Last Update Date | 2021-09-03 |