| NPI | 1144794744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WY PPC-1388) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2019-01-16 |
| Last Update Date | 2023-06-06 |