| NPI | 1386329860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2023-06-21 |
| Last Update Date | 2025-01-09 |