| NPI | 1780229369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 103TS0200X Psychologist, School |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2019-11-07 |
| Last Update Date | 2019-12-19 |