| NPI | 1609088491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2024-09-05 |