| NPI | 1417225244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA OH35778) |
| Enumeration Date | 2011-12-07 |
| Last Update Date | 2023-06-30 |