| NPI | 1437639440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA 140816) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 101Y00000X Counselor | |
| Enumeration Date | 2018-08-19 |
| Last Update Date | 2026-09-10 |