| NPI | 1487788469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCS22310) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: CA 22310) |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2023-06-05 |