NPI | 1215413331 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 172V00000X Community Health Worker |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
172V00000X Community Health Worker | |
261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
Enumeration Date | 2018-07-11 |
Last Update Date | 2023-05-19 |