| NPI | 1962655407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OR 02944) |
| 171M00000X Case Manager/Care Coordinator (Licence: OR 2221097) | |
| Enumeration Date | 2008-10-28 |
| Last Update Date | 2023-10-25 |