| NPI | 1730501495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL IMH25041) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2014-01-15 |
| Last Update Date | 2024-11-16 |