| NPI | 1780388975 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 172V00000X Community Health Worker | 
| Additional Taxonomies | 101YM0800X Counselor, Mental Health | 
| 104100000X Social Worker | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2023-03-30 | 
| Last Update Date | 2025-07-03 |