| NPI | 1457644783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 111794) |
| Enumeration Date | 2011-05-19 |
| Last Update Date | 2022-02-28 |