| NPI | 1265797229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 174H00000X Health Educator |
| 171M00000X Case Manager/Care Coordinator | |
| 171400000X Health & Wellness Coach | |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2012-07-05 |
| Last Update Date | 2023-12-21 |