| NPI | 1518469923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA 102548) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 102548) |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2018-03-01 |
| Last Update Date | 2021-08-06 |