| NPI | 1801505466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 171W00000X Contractor |
| 172V00000X Community Health Worker | |
| 174H00000X Health Educator | |
| 225A00000X Music Therapist | |
| 171M00000X Case Manager/Care Coordinator | |
| 374K00000X | |
| 101YP1600X Counselor, Pastoral | |
| 106S00000X Behavior Technician | |
| 171400000X Health & Wellness Coach | |
| Enumeration Date | 2022-11-22 |
| Last Update Date | 2023-12-18 |