| NPI | 1467939710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 174H00000X Health Educator | |
| Enumeration Date | 2018-07-19 |
| Last Update Date | 2018-07-19 |