| NPI | 1174165369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 140601) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 101Y00000X Counselor | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-10-09 |
| Last Update Date | 2026-07-29 |