| NPI | 1124379730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 171M00000X Case Manager/Care Coordinator | |
| 322D00000X Residential Treatment Facility, Emotionally Disturbed Children | |
| Enumeration Date | 2012-09-21 |
| Last Update Date | 2023-12-22 |