| NPI | 1245743582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 103TE1100X Psychologist, Exercise & Sports | |
| 104100000X Social Worker | |
| 133N00000X Nutritionist | |
| 133NN1002X Nutritionist, Nutrition, Education | |
| 171M00000X Case Manager/Care Coordinator | |
| 172V00000X Community Health Worker | |
| 251B00000X Case Management | |
| Enumeration Date | 2017-11-08 |
| Last Update Date | 2017-11-08 |