| NPI | 1558612994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 101YM0800X Counselor Mental Health | |
| Enumeration Date | 2012-09-25 |
| Last Update Date | 2022-09-22 |