| NPI | 1811486012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2018-05-03 |
| Last Update Date | 2020-07-28 |