| NPI | 1720706864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 373H00000X Day Training/Habilitation Specialist | |
| Enumeration Date | 2022-08-15 |
| Last Update Date | 2026-05-07 |