| NPI | 1023757580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: CA 118654) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 172V00000X Community Health Worker (Licence: CA 118654) | |
| 106H00000X Marriage & Family Therapist (Licence: CA 118654) | |
| Enumeration Date | 2022-06-02 |
| Last Update Date | 2024-09-17 |