| NPI | 1699318980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 251B00000X Case Management |
| 261QM0850X Clinic/Center Adult Mental Health (Licence: FL SW22886) | |
| 261QM0855X Clinic/Center Adolescent and Children Mental Health (Licence: FL SW22886) | |
| Enumeration Date | 2019-10-20 |
| Last Update Date | 2024-04-27 |