| NPI | 1437865391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2023-01-24 |
| Last Update Date | 2023-02-24 |