| NPI | 1225431349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 99132) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA ASW99132) |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2014-10-02 |
| Last Update Date | 2021-06-16 |