| NPI | 1295411320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 104100000X Social Worker |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2023-06-23 |
| Last Update Date | 2023-06-23 |