| NPI | 1427417229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MI 6803086215) |
| Enumeration Date | 2016-02-22 |
| Last Update Date | 2025-03-14 |