| NPI | 1285103119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 172V00000X Community Health Worker | |
| 101Y00000X Counselor | |
| Enumeration Date | 2018-11-21 |
| Last Update Date | 2023-05-16 |