| NPI | 1598353419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA 61171565) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: WA 61171565) |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2021-01-06 |
| Last Update Date | 2021-05-18 |