| NPI | 1679778153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA MC61138315) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YP2500X Counselor, Professional (Licence: WA RC00049521) | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2007-06-15 |
| Last Update Date | 2025-03-20 |