| NPI | 1396400388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YS0200X Counselor, School |
| Additional Taxonomies | 101Y00000X Counselor |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2021-11-03 |
| Last Update Date | 2025-05-21 |