| 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 |