| NPI | 1679778153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YP2500X Counselor, Professional (Licence: WA RC00049521) | |
| Enumeration Date | 2007-06-15 |
| Last Update Date | 2022-01-04 |