| NPI | 1750761391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174H00000X Health Educator |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor, Mental Health | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2015-06-08 |
| Last Update Date | 2025-06-26 |