| NPI | 1336592997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA 117205) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 101Y00000X Counselor | |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2016-07-19 |
| Last Update Date | 2023-09-21 |