| NPI | 1275043374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 171M00000X Case Manager/Care Coordinator | |
| 101YP2500X Counselor, Professional | |
| Enumeration Date | 2017-10-03 |
| Last Update Date | 2026-01-22 |