| NPI | 1548770639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 101Y00000X Counselor |
| 172V00000X Community Health Worker | |
| 175T00000X Peer Specialist | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-10-03 |
| Last Update Date | 2024-03-06 |