| NPI | 1508499062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 91961) |
| 104100000X Social Worker (Licence: CA ACSW91961) | |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2020-02-12 |
| Last Update Date | 2023-10-09 |