| NPI | 1578367934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 1528435419) |
| Enumeration Date | 2025-04-03 |
| Last Update Date | 2025-04-03 |