| NPI | 1841500709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 10382212-3501) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: UT 10382212-3501) |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2010-10-13 |
| Last Update Date | 2024-03-29 |