| NPI | 1740446020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YS0200X Counselor, School (Licence: NV 74303) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2008-08-05 |
| Last Update Date | 2010-11-01 |