| NPI | 1598149080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 10386) |
| Enumeration Date | 2015-07-14 |
| Last Update Date | 2024-09-24 |