| NPI | 1528540168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2018-08-30 |
| Last Update Date | 2024-05-09 |