| NPI | 1023764594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 18224) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2022-02-23 |
| Last Update Date | 2024-12-18 |