| NPI | 1225693609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 101Y00000X Counselor |
| 171M00000X Case Manager/Care Coordinator | |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2019-05-01 |
| Last Update Date | 2024-06-18 |