| NPI | 1366867657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NV 2600020087) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: NV 2600020087) |
| Enumeration Date | 2014-02-24 |
| Last Update Date | 2014-02-24 |