| NPI | 1548101371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA MHC.LH.60269192) |
| Enumeration Date | 2026-04-04 |
| Last Update Date | 2026-05-18 |