| NPI | 1578033288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MD LC12606) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MD LC12606) |
| 101YP2500X Counselor, Professional (Licence: MD LC12606) | |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2018-11-26 |
| Last Update Date | 2022-06-15 |