| NPI | 1871040261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 171M00000X Case Manager/Care Coordinator | |
| 226000000X Recreational Therapist Assistant | |
| Enumeration Date | 2016-09-02 |
| Last Update Date | 2023-12-20 |