| NPI | 1891330700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174H00000X Health Educator |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 246Z00000X Specialist/Technologist, Other | |
| Enumeration Date | 2019-11-14 |
| Last Update Date | 2025-08-06 |