| NPI | 1326518853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 20127) |
| Enumeration Date | 2018-11-27 |
| Last Update Date | 2024-05-13 |