| NPI | 1336625557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 251S00000X Community/Behavioral Health | |
| Enumeration Date | 2018-07-11 |
| Last Update Date | 2024-04-03 |