| NPI | 1770108615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174V00000X Clinical Ethicist |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 171W00000X Contractor (Licence: OR 528312) | |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2020-06-16 |
| Last Update Date | 2023-03-17 |