| NPI | 1043031115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174H00000X Health Educator |
| Additional Taxonomies | 251S00000X |
| 101YP1600X Counselor, Pastoral | |
| 171000000X Military Health Care Provider | |
| 175T00000X Peer Specialist | |
| 405300000X Prevention Professional (Licence: FL 3758428) | |
| Enumeration Date | 2024-10-22 |
| Last Update Date | 2024-10-22 |