| NPI | 1700167103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 172A00000X Driver |
| 172V00000X Community Health Worker | |
| 225400000X Rehabilitation Practitioner | |
| 246RP1900X Technician, Pathology, Phlebotomy | |
| Enumeration Date | 2011-08-30 |
| Last Update Date | 2023-05-26 |