| NPI | 1689100604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA 11813) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2025-10-01 |