| NPI | 1497417596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA ASW116562) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2021-10-06 |
| Last Update Date | 2023-08-24 |