| NPI | 1184044588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA ASW117834) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 172V00000X Community Health Worker | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-04-24 |
| Last Update Date | 2023-09-13 |