| NPI | 1871776955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2007-12-11 |
| Last Update Date | 2014-04-03 |