| NPI | 1265091532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH C.2103113) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: OH APP-000270513) |
| Enumeration Date | 2019-06-11 |
| Last Update Date | 2021-01-22 |