| NPI | 1205619921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 172V00000X Community Health Worker (Licence: CA 1205619921) | |
| Enumeration Date | 2023-08-16 |
| Last Update Date | 2025-02-07 |