| NPI | 1053040618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 101YM0800X) |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2022-06-08 |
| Last Update Date | 2022-09-09 |