| NPI | 1720123417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C1693) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: OR 05-07-69U3) |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2018-03-17 |