| NPI | 1346724382 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 101Y00000X Counselor |
| 172V00000X Community Health Worker | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-09-15 |
| Last Update Date | 2024-12-06 |