| NPI | 1326561267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker (Licence: CA 105411) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 105411) |
| 104100000X Social Worker (Licence: CA 105411) | |
| 104100000X Social Worker | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-07-23 |
| Last Update Date | 2022-12-02 |