| NPI | 1437964897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 148442) |
| Enumeration Date | 2025-02-11 |
| Last Update Date | 2025-10-02 |