| NPI | 1245774785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA 103169) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 172V00000X Community Health Worker (Licence: CA 103169) | |
| Enumeration Date | 2016-12-16 |
| Last Update Date | 2023-09-01 |