| NPI | 1568818474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MA S15309944) |
| Enumeration Date | 2016-05-10 |
| Last Update Date | 2020-08-27 |