| NPI | 1770620668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YM0800X Counselor, Mental Health | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2024-02-09 |