| NPI | 1174068225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA ASW95667) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2016-12-28 |
| Last Update Date | 2020-07-29 |