| NPI | 1124484605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA 94917) |
| 1041C0700X Social Worker Clinical (Licence: NC P009812) | |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2016-01-13 |
| Last Update Date | 2020-12-09 |