| NPI | 1023821097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA ASW135903) |
| Enumeration Date | 2025-01-31 |
| Last Update Date | 2026-07-21 |