| NPI | 1639671662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA ASW115058) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2018-03-06 |
| Last Update Date | 2023-05-20 |