| NPI | 1093533382 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 104100000X Social Worker (Licence: CA 132817) | 
| Additional Taxonomies | 104100000X Social Worker | 
| 172V00000X Community Health Worker | |
| 373H00000X Day Training/Habilitation Specialist | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2024-09-26 | 
| Last Update Date | 2025-08-07 |