| NPI | 1356793129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor, Mental Health | |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2016-07-05 |
| Last Update Date | 2022-05-18 |