| NPI | 1598575953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 19898) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2025-01-08 |
| Last Update Date | 2025-07-21 |